Skinterview with Eczema Expert and Dermatologist, Dr. Peter Lio

In honor of National Eczema Awareness month, our resident eczema specialist and board-certified dermatologist at Dermveda, Dr. Vivian Shi, interviewed integrative eczema expert, Dr. Peter Lio. Dr. Lio is a Clinical Assistant Professor of Dermatology & Pediatrics at Northwestern University Feinberg School of Medicine. He received his medical degree from Harvard Medical School, completed his internship in Pediatrics at Boston Children’s Hospital, and his Dermatology training at Harvard where he served as Chief Resident in Dermatology. Dr. Lio is the founding director of the Chicago Integrative Eczema Center, and has spoken nationally and internationally about atopic dermatitis, as well as alternative medicine.

Skinterview with Dr. Peter Lio

Dr. Shi: Why do you think eczema has become the poster child for complementary and alternative medicine (CAM)?

Dr. Lio: I think that when we don't have great explanations for diseases, when our treatments seem more "symptomatic" rather than getting to the root of the issue, and when there are safety concerns about those treatments, then the environment is ripe for alternatives. For better or for worse, atopic dermatitis certainly meets these criteria! Coupled with how common the affliction is and the accessibility of the skin, there are so many voices about how to treat it, how to prevent it, and what is really going on with it, that it very confusing for both patients and practitioners alike.

Dr. Shi: What is one product or medication in your eczema tool belt that you cannot live without?

Dr. Lio: Moisturizers are, to me, the foundation of good eczema care. We know that in some patients there is "leaky skin" from the get-go: a genetic deficiency in the skin barrier, such as with the FLG gene making filaggrin. But, even in patients who have normal genes, we know that in the presence of inflammation, they make less filaggrin and, therefore, develop skin barrier problems. Thus, in any case, we have to support the "leaky skin" and moisturizers do this beautifully and safely.

Dr. Shi: What is most challenging part of treating eczema? What's the most gratifying?

Dr. Lio: The most challenging part is when patients or families hear mixed messages: that eczema is just a form of food allergy, or that it's caused by toxins, or that topical steroids are super dangerous and should never be used. The hard part is, that each of these examples has some nugget of truth (some foods can indeed trigger eczema, staph bacteria makes a toxin called "delta-toxin" that seems to fuel eczema, and topical steroids do have real side effects and have to be used carefully and under close supervision). Sorting through all these concerns, fears, thoughts, and ideas can be very difficult, especially because "we" (the Royal we, meaning the medical establishment here) don't have all the answers. 

At the same time, winning the trust of and having good rapport with a patient and watching them improve and respond to treatment, despite initial concerns, is the most gratifying. I suppose that is why I stay open to even the most difficult cases; even the folks who have seen 5 other doctors and have apparently failed every treatment. Those are the cases that if we can work together and find a way to get them better, there is a tremendous feeling of achievement.

Dr. Shi: What do you tell patients or parents who want to avoid topical steroids and medications, and prefer natural or alternative options for treating eczema?

Dr. Lio: There is a lot here to discuss and there are some really good natural treatments for eczema. Things like natural moisturizers (such as sunflower seed oil), natural antibacterials (such as coconut oil), natural anti-inflammatory treatments (such as vitamin B12 applied topically), acupuncture, and even more powerful treatments, such as light therapy and balneotherapy (going to a spa or natural spring), can all be used with great effect. Sometimes, however, for the more severe patients, I do try to integrate some western therapies as well, as, in my experience, there are limits to what the more gentle, more natural treatments can accomplish for most patients.

Dr. Shi: Since October is Eczema Awareness month, what is the # 1 eczema issue you would like to address within the eczema community?

Dr. Lio: I'd love to see us address steroid phobia and topical steroid withdrawal so that we can enhance awareness and be able to use these treatments safely and properly so that we avoid side effects but are able to give patients relief from the terrible suffering of eczema.